should parenting programmes to improve children's life chances address child behaviour, reading...
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This article was downloaded by: [Bibliothèques de l'Université de Montréal]On: 10 December 2014, At: 08:15Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK
European Journal ofDevelopmental PsychologyPublication details, including instructions for authorsand subscription information:http://www.tandfonline.com/loi/pedp20
Should parenting programmes toimprove children's life chancesaddress child behaviour, readingskills, or both? Rationale for theHelping Children Achieve trialStephen Scott a , Kathy Sylva b , Celia Beckett a ,Angeliki Kallitsoglou a , Moira Doolan a & Tamsin Ford ca Institute of Psychiatry and National Academy forParenting Research, King's College London , London ,UKb Department of Education , Oxford University ,Oxford , UKc Peninsula Medical School , Exeter , UKPublished online: 23 Jan 2012.
To cite this article: Stephen Scott , Kathy Sylva , Celia Beckett , Angeliki Kallitsoglou ,Moira Doolan & Tamsin Ford (2012) Should parenting programmes to improve children'slife chances address child behaviour, reading skills, or both? Rationale for the HelpingChildren Achieve trial, European Journal of Developmental Psychology, 9:1, 47-60, DOI:10.1080/17405629.2011.643172
To link to this article: http://dx.doi.org/10.1080/17405629.2011.643172
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Should parenting programmes to improve children’s life
chances address child behaviour, reading skills, or both?
Rationale for the Helping Children Achieve trial
Stephen Scott1, Kathy Sylva
2, Celia Beckett
1,
Angeliki Kallitsoglou1, Moira Doolan
1, and Tamsin Ford
3
1Institute of Psychiatry and National Academy for Parenting Research, King’s
College London, London, UK2Department of Education, Oxford University, Oxford, UK3Peninsula Medical School, Exeter, UK
Behaviour problems and poor literacy levels are each independently associatedwith a lower quality of life in childhood, and carry forward to predict muchpoorer outcomes in adulthood. Longitudinal surveys show that the dimensionsof parenting that influence child behaviour and child literacy differ. The aspectsof parenting that promote good behaviour concern the quality of therelationship, for example giving warmth and encouragement while calmlyenforcing clear limits. In contrast, the aspects that promote literacy are regularreading with the child in a manner that is sensitive to their ability level. To helpchildren with difficulties, there are many evidence-based parenting programmesto improve parent–child relationship quality, but very few address literacy. Thispaper reviews evidence on these issues, illustrated by our own previouspreventive trials that combined a parenting programme addressingrelationships (Incredible Years; IY) with a new parenting programmeaddressing literacy (Supporting Parents on Kids Education; SPOKES).Because this combination improved both child behaviour and literacy, a newrandomized controlled trial called Helping Children Achieve is underway todisentangle the mode of action of each component by comparing the effects of:(1) a relationship programme alone (IY); with (2) a literacy programme alone(SPOKES); (3) both combined; and (4) an information helpline (control group).The results are not yet known but should answer whether programmes thattarget relationships also improve child literacy, and whether programmes thattarget literacy also improve behaviour. The findings will inform strategies toreduce social inequality and help young children achieve their potential.
Correspondence should be addressed to Stephen Scott, Box P85, Department of Child and
Adolescent Psychiatry, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
E-mail: [email protected]
EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY2012, 9 (1), 47–60
� 2012 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business
http://www.psypress.com/edp http://dx.doi.org/10.1080/17405629.2011.643172
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Keywords: Conduct problems; Parenting programme; Randomized controlledtrial; Reading intervention.
Persistent antisocial behaviour in children is common: oppositional-defiantand conduct disorders (ODD/CD) affect 5% of the population (Fergusson,Horwood, & Ridder, 2005). The children are seriously impaired: at home,they evoke criticism and have few friends, and at school they are disruptiveand typically leave with no qualifications (Fergusson et al., 2005). There isstrong continuity to adulthood criminality, drug and alcohol misuse, andunemployment—the effects here are big, with the odds ratio for each ofthese outcomes showing they are around five times more likely (Fergussonet al., 2005). The public cost of a high-risk youth over the lifetime has beenestimated to be $2.6–$4.4 million (Cohen & Piquero, 2009) and individualswith conduct disorder aged 10 cost society ten times as much as controls byage 28 (Scott, Knapp, Henderson, & Maughan, 2001).
European and American governments have made tackling child antisocialbehaviour a priority. For example, in Norway, Sweden and England therehave been national initiatives rolling out evidence-based parentingprogrammes on a large scale (Scott, 2010). The UK Allen review on earlyinterventions (2011) recommends the wide implementation of evidence-based parenting programmes. The US National Academies of Science’s(2009) report on the prevention of mental, emotional and behavioural(MEB) disorders stated that:
Research on the prevention of MEB disorders should focus on interventions thatoccur before the onset of disorder but should broaden the range of outcomes toinclude accomplishment of age-appropriate developmental tasks (e.g., school,social, and work outcomes).
The call for innovative early interventions has arisen because currenttreatments for established antisocial behaviour are unsatisfactory. First, evenin well-developed countries, only a minority of cases meeting criteria forODD/CD receive specialized help, e.g., a quarter in England (Ford,Hamilton, Goodman, & Meltzer, 2005). Second, many specialist treatmentsoffered are not grounded in empirically based theory, but rather on generalbeliefs about psychotherapeutic counselling or medication. Third, manychildren and families only receive treatment in later childhood oradolescence, when outcomes are poorer (National Academies of Science,2009). Fourth, treatments shown to be efficacious in the university clinicsof their originators typically show little effectiveness in independentreplications in ‘‘real-life’’ practice (Weisz, Doss, & Hawley, 2006). Fifth,most child mental health services are for clinically referred cases: there arerelatively few routinely delivered prevention programmes. There istherefore a need to develop and test interventions that address these
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issues by offering a service early on in child development starting with awhole population—i.e., primary prevention or early intervention—ratherthan only waiting until children are older to offer ‘‘treatment’’ when thecondition is more severe and entrenched.
If early interventions are to be maximally effective, it is important thatthey draw upon modern scientific studies, which show that several differentfactors influence the emergence of antisocial behaviour. Four factors thatindependently contribute to poor outcomes are: (1) hostile parenting(Loeber & Farrington, 2000); (2) the frequency and severity of conductsymptoms (Loeber & Farrington, 2000); (3) ADHD symptoms (Taylor,Chadwick, Heptinstall, & Danckaerts, 1996); and (4) poor reading ability(Trzesniewski, Moffitt, Caspi, Taylor, & Maughan, 2006). In planning ourown intervention, we wished to address all four risk factors through thesingle portal of parental behaviour.
IMPACT OF EARLY PARENTING INVOLVEMENT ONCHILD COGNITIVE AND BEHAVIOURAL
DEVELOPMENT
While improving parenting to address antisocial behaviour and attentionproblems is well established, its potential to improve child reading is littletested. Poor reading is much more common in families from disadvantagedbackgrounds. In England, the recent Field Review (2010) on Poverty andLife Chances noted:
[C]children from poorer backgrounds perform worse cognitively and behaviourallythan those from more affluent homes [while schools] do not effectively close thatgap; children who arrive in the bottom range of ability tend to stay there. (p. 5)
The question arises as to what components lead to the Socio EconomicGroup (SEG) gap, and what can be done about it? The role of parentingpractices has been investigated as particularity relevant, and in general,lower SEG is associated with less optimal parenting practices (Ghate &Hazel, 2002). In relation to educational attainment, several longitudinal(non-interventional) studies have found parental involvement was key.Sylva, Melhuish, Sammons, Siraj-Blatchford, and Taggart (2010) found thatthe home-learning environment was more powerful in predicting attainmentscores at age 11 in English and mathematics than was parental SEG. Theyfound that parental support for their children’s learning (for example,reading to children, teaching them about sounds and letters) was a powerfulpredictor of school-readiness even after taking into account factors such asparental education, poverty, and home language. Controlling for parentaleducation was important since it acts as a reasonable proxy for parental IQ,which is seldom measured in these studies, yet is an alternative explanation
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for the SEG gap. These studies suggest that general parental involvementand a stimulating home environment influence attainment. However, theparticular contribution of parents’ reading with their children to childreading attainment is less clear. The meta-analysis by Bus, van IJzendoorn,and Pellegrini (1995) found that whether parents read with their children ornot accounted for only 8% of the variance in literacy development. Bycontrast, in a multivariate analysis of the factors that account for thedisparities in attainment seen in 4-year-olds in the USA, Waldfogel andWashbrook (2008) noted that after controlling for demographic factorsincluding income and maternal education, parental relating style emerged asthe single largest domain explaining the poorer cognitive performance oflow-income children relative to middle-income children, accounting for 33%of the gap in language (4.4 points of the 13 percentile point gap). Theparticular parenting dimension of maternal sensitivity and responsivenessaccounted for over half of the effect on its own. A second important aspectwas the parental support for learning. This includes parents’ teachingbehaviours in the home as well as their provision of learning materials andactivities, such as books. Taken together, parenting style and home-learningenvironment accounted for between a third and a half of the gaps betweenpoor and middle-income children. In summary, while the longitudinalstudies do, indeed, confirm the strong association between parentalinvolvement and child reading attainment, both the general quality of theparent–child relationship (e.g., sensitive responding) and the specific way theparent supports intellectual development and literacy seem to be importantin promoting reading skills, though they do not emerge as majordeterminants in all studies.
Given this growing evidence from developmental psychology thatmultiple factors influence children’s development, one might hope theywould be targeted in interventions. However, in general, clinicians andteachers have often been slow to incorporate this knowledge into theirpractice. Most interventions address only one factor, for example familyfunctioning, or child cognitions. However, there have been some exceptionsin the last decade, with a few high-quality prevention trials that haveaddressed multiple targets. For example, Webster-Stratton, Reid, andStoolmiller (2008) combined parent training with child social skills trainingto good effect. To include the target of educational attainment as well as theparent–child relationship, some programmes have added teacher-led literacyor school behaviour components (e.g., Barkley et al., 2000; Tolan, Gorman-Smith, & Henry, 2004). Fast Track was a model efficacy trial, with sixseparate types of intervention, including teacher-led remedial reading, butthe mean effect size (es) on antisocial behaviour was 0.11 standarddeviations (SDs; Conduct Problems Prevention Research Group, 1999).Finally, The Early Risers programme in the USA offered a multicomponent
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intervention with teacher-led reading and socioemotional learning for thechild, and home-delivered parent training. The initial trial (August,Realmuto, Hektner, & Bloomquist, 2001) showed improvements in reading(es 0.26), but a subsequent dissemination trial failed to find significant effects(August, Bloomquist, Lee, Realmuto, & Hektner, 2006). In summary, theseinnovative multicomponent interventions have been relatively expensive todeliver and have had mixed results. In contrast, programmes in schools thattarget reading alone have been more successful, such as Reading Recovery(Hurry & Sylva, 2007) led by teachers. However, none of these studiesincluded a parent-led reading intervention.
RATIONALE FOR THE DESIGN OF OURPREVENTION STUDIES
We had several goals:
1. To develop an early intervention that would address behaviour andreading;
2. To target children at risk of poor outcomes due to antisocialbehaviour;
3. To take a whole-population approach rather than just see childrenwho were referred due to parental or teacher concern, so that nochildren were missed;
4. To intervene early in their school career; and5. To make the intervention not too costly.
To address child behaviour, we chose the basic Incredible Years programme(Webster-Stratton, 1998), which we had proven effective in an earliercontrolled trial with clinically referred antisocial children in improvingparenting, child antisocial behaviour, and child attending ability/ADHDsymptoms (Scott, Spender, Doolan, Jacobs, & Aspland, 2001). To addressreading, we wished to produce a literacy programme for parents based oncontemporary theory. We took the view that just encouraging parents to readwith their children would not be maximally effective. Given the findings onthe associations between parental involvement and child reading cited above,it might seem ‘‘common sense’’ that promoting general parental involvementin reading would lead to better educational outcomes. However, there is littleevidence to support this. For example, Mattingly, Prislin, McKenzie,Rodriguez, and Kayzar (2002) reviewed 41 studies that evaluated parentalinvolvement programmes. They found ‘‘little empirical support for thewidespread claim that parental involvement programmes are an effectivemeans of improving student achievement or changing parent, teacher andstudent behaviour’’. The review by Phillips, Norris, and Anderson (2008)
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reconfirmed this finding, and cited evidence that the usual way parents readto their children was unlikely to be very effective because typically they pointto the pictures, whereas if parents were to also carefully direct their children’sattention to words in print, this would be more likely to be effective.
We therefore developed a manualized programme for groups of 5 to 12parents (Sylva, Scott, Totsika, Ereky-Stevens, & Crook, 2008). It beginswith a ‘‘whole language’’ approach to reading, where parents areencouraged to discuss the child’s book, to link the text to the child’severyday experiences and to help the child ‘‘predict’’ what might happennext. Next, they are encouraged to play rhyming games with their childrenand to ‘‘discover’’ print in their ordinary environment, e.g., the names ofcereals, trainers, etc. It then teaches the Pause Prompt Praise (McNaughton,Glynn, & Robinson, 1987) approach to reading. When a child encounters anunknown word, the parent is taught to pause for five seconds; if the childdoesn’t succeed, the parent gives a specific prompt, and then praises thechild for trying. Other elements included role-play of effective book sharing,literacy tasks and literacy games at home, a visit to the local library, familyliteracy workshops, and two home visits to observe shared reading. Thisapproach gives parents techniques to encourage their children’s use of anactive problem-solving approach to reading. Our original manual waswritten in 2000, and was used in the SPOKES and PALS trial describedbelow. It has now been updated for the latest Helping Children Achieve(HCA) trial to take account of recent empirical evidence about how childrenlearn to read, specifically by including more phonics activities (Departmentfor Children, Schools and Families, 2008). The revised programme (Sylva,Price, Crook, & Roberts, 2011) is delivered through two-hour sessions eachweek over ten weeks.
Two leaders run the parents’ groups. To deliver the IY programme theyare expected to have qualifications and experience in a helping professionand to have completed an IY group leader training. To run the SPOKESliteracy programme they are additionally expected to be teachers or have astrong background in education theory. Then they are trained in the literacyprogramme by observing a literacy group for 12 weeks, then co-running agroup, while receiving weekly supervision from the programme originators.Then, if found competent, they can lead groups. To maintain fidelity, allgroups are videotaped and weekly supervision is held.
EFFECTS OF COMBINING RELATIONSHIP ANDREADING PROGRAMMES: THE SPOKES AND PALS
TRIALS
In the first trial, called Supporting Parents on Kids’ Education in Schools(SPOKES; Sylva et al., 2008; Scott, Sylva et al., 2010), 936 4- to 6-year-old
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children were screened for antisocial behaviour, by teachers and parentsfilling in the Strengths and Difficulties Questionnaire (Goodman, 2001).Then parents of 112 high-scoring children were randomized to parentinggroups held in schools, or to a no-intervention control condition; 109 werefollowed-up a year later. The intervention, as described above, combined thebasic Incredible Years programme (12 weeks), followed by the SPOKESliteracy programme (a further 10 weeks) then there was a six-week booster.Parents in the control group received a telephone information helpline.Assessment of conduct problems was by parent interview, parenting bydirect observation and child reading by psychometric testing.
The results showed that at follow-up, parents allocated to theintervention used play, praise and rewards more often than controls, andharsh discipline less. Effect sizes ranged from 0.31 to 0.59 SDs. Compared tocontrol children, whose behaviour didn’t change, intervention children’sconduct problems reduced by 0.52 SDs, dropping from the 80th to the 61stpercentile; Oppositional Defiant Disorder halved from 60% to 31%. ADHDsymptoms reduced by 0.44 SDs, and reading age improved by six months(0.36 SDs). Teacher-rated behaviour didn’t change. The programme cost£2,380 ($3,800) per child.
These results were encouraging. However, the amount of time parentswere expected to attend, 28 weeks, or most of the school year (once a weekfor 2½ out of 3 school terms) meant that the intervention was relatively timeconsuming and expensive. We therefore changed the combined interventionin three ways: (1) we made it shorter—16 rather than 28 weeks—so groupleaders could deliver it twice in the school year; (2) we used less-expensive,less-well-qualified staff—they had psychology degrees, but not higherprofessional training in, for example, clinical psychology, family therapy,or mental health nursing; (3) we made it universally available to anyinterested parents, whose children often had no behaviour problems, butalso encouraged those with at-risk children to attend. We then tested itseffectiveness in a very disadvantaged, multi-ethnic area in Inner London.
The second trial was called the Primary Age Learning Skills (PALS) trial(Scott, O’Connor et al., 2010) and randomized parents of 174 children, whowere selected from a population of 672 5- and 6-year-olds. Eighty-eightchildren were allocated to the Incredible Years preventive programme plus ashortened six-week version of the SPOKES literacy programme; 86 to usualcommunity services. Of the families, 152/174 (87%) were successfullyfollowed-up. Two-thirds (58/89) of those offered the parenting programmeattended at least one session, with similar enrolment rates across ethnicgroups. Mean attendance was four sessions on relationship building and oneon literacy development. At follow-up after one year, intervention familiesshowed significant improvements in the parent–child relationship onobservation and at interview compared to controls. However, child
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behaviour problems and reading did not improve. The cost was £1,343($2,100) per child. The differences between the two trials are shown inTable 1.
While the observed changes on the parenting quality were encouraging,the failure to improve child outcomes was disappointing. It was unlikely tobe due to the parent–child programme chosen, as it has worked in manyprevious trials. Ethnicity was also unlikely to be the reason since all ethnicgroups changed similarly in their parenting practices. Therapist skill was apossible contributor. The group leaders did not have a professional clinicaltraining, although even if the skill level was not the very highest, the levelwas as good is likely to be found in typical ‘‘real-life’’ dissemination. A morelikely contributor to the lack of child effects was low attendance rates.Although several parenting practices changed, the overall mean number ofsessions attended was only five. However, this finding is in line with similaruniversal prevention trials (Webster-Stratton, 1998; Webster-Stratton, Reid,& Hammond, 2001) and greater attendance is associated with larger effectsacross more dimensions of parenting (Reid, Webster-Stratton, & Baydar,2004). Finally, perhaps the single greatest factor reducing effectiveness wasthe initial level of child difficulty, which was no greater than the populationmean. This had two consequences: first, there was little room for measurable
TABLE 1Comparison of SPOKES and PALS early intervention trials
SPOKES PALS
% ethnic minority families 25% 75%
Intervention targeted or universal? Targeted at most
antisocial 18% of
population
Universal offer plus
targeted subgroup
Mean severity of children’s
antisocial behaviour (percentile
ranking, national norms)
Worst 18% of
population
50th percentile of
population
Background of therapists Professional (e.g.,
clinical psychologist,
family therapist)
Psychology graduate, no
mental health training
Number of sessions attended by
parents/number offered
14/26 5/16
Improvements in parenting
measures (es)
.31 to .59 SD .33 to .42 SD
Improvements in child antisocial
behaviour (es)
.52 SD None
Improvements in child ADHD
symptoms (es)
.44 SD None
Improvements in child reading (es) .36 SD None
Note: es¼ effect size.
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improvement. Trials of the same programme that only take more severelyaffected children typically achieve improved child outcomes (Hutchingset al., 2007), and within trials with mixed severity levels, the more antisocialchildren change more (Reid et al., 2004). Second, attendance is poorer forparents whose children lack problems (Reid et al., 2004). Other investigatorshave found a similar pattern in prevention trials, with no changes in childoutcomes, and often none in parenting either (e.g., August et al., 2006;Barkley et al., 2000; Webster-Stratton et al., 2001).
DISENTANGLING THE EFFECTS OF RELATIONSHIPAND READING PROGRAMMES: THE HELPING
CHILDREN ACHIEVE (HCA) TRIAL
Having hypothesized the reasons why the PALS trial may have had nomeasurable effects on child outcomes, we wished to do a further trial: (1) tosee if child outcomes would improve if we were to control for some of thesevariables; and () to disentangle the effects of the two different types ofparenting intervention, i.e., relationship and reading. We therefore set up anew trial in 2008, which is now approaching completion, the HCA Trial(National Academy for Parenting Research, 2011). This uses clinicallyqualified intervention staff, includes severe and mild cases of antisocialbehaviour, and takes place in two sites, one multiethnic and onepredominantly White British. To tease out which intervention elementsare responsible for which improvement, the trial has four arms, comparing:(1) teaching parents to support their children’s reading; vs. (2) teaching themto have a better general relationship; vs. (3) both interventions combined; vs.(4) a no intervention control group. All arms of the trial are being evaluatedfor their relative contribution to improving reading and behaviour, since it ispossible that the reading intervention may improve behaviour, and, viceversa, children who are emotionally more settled and behaving better maybecome better readers. This is the first trial of its type in the world.
While the longitudinal studies cited in the introduction suggest specificityof parenting impact, i.e., parenting that promotes the development ofemotions and relationship skills leads to better behaviour, whereasparenting that promotes literacy skills leads to better educational attain-ment, this has seldom been tested in interventions. Thus, no study hasspecifically tested whether improving the parent–child relationship also leadsto better reading, or, vice versa, whether interventions that improve readinglead to better child behaviour and social adjustment. Yet the recent meta-analysis of universal social and emotional learning interventions in schoolsfound that they also improved reading and academic performance (es 0.27;Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011), suggesting thatimproving a child’s emotional state may also improve reading. Rhoades,
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Warren, Domitrovich, and Greenberg (2011) suggest that improvedattending skills may be the mechanism through which this worked. Thismechanism now needs to be tested with regard to improved parent–childemotional relationships: it is entirely possible that increased parentalwarmth and sensitivity may engender better reading, either directly or byimproving attention. Equally, it is possible that children who read bettermay behave better. This could be because their self-esteem goes up and theyare less frustrated in school, or because they feel better attended to by theirparents and hence respect them more and are more compliant (as in classicalsocial learning theory).
As well as evaluating the straightforward outcomes in each arm of thetrial and investigating whether the combined intervention has synergisticeffects, we will investigate mediators and moderators, such as the role ofimproved parental relating style versus improved parental support forreading in advancing child reading and improved child behaviour. If any ofthe above mechanisms of change is present, the extent to which they aremoderated by parental or child variables will be examined: parentalcharacteristics (e.g., is the intervention less effective for parents with lowereducational qualifications, less skilled occupations, lower income, or Englishas an Additional Language?); child characteristics (e.g., child age, gender,IQ, English as an Additional Language), and child behaviour (e.g.,antisocial behaviour, poor attention, lower reading ability, attachmentsecurity). Attention skill will be tested both as a moderator and a mediator.See Figure 1 for a diagram of the study design.
Methods
Two recruitment strategies are being used, a population screen on thechildren as used in the previous trials, to capture a lower risk earlyintervention sample, and a referred higher risk sample. Focus groups withparents shaped the nature of the trial; they emphasized the importance ofintervening early, so 200 children of primary school age (50 per arm; aged 5–7 years) are being recruited. The sites are a multi-ethnic inner-London area,and a predominantly White British city in the south west of England. Amulti-method, multi-informant approach is being used for assessments.Parents and children are being given questionnaires, semi-structuredinterviews, and are being directly observed, in order to assess parent andchild psychopathology, parent–child interaction, verbal IQ, and literacy/reading abilities. Teachers complete questionnaires. Measures are shown inTable 2. The interventions will be the ‘‘Incredible Years’’ (IY; Webster-Stratton, 1998) school age programme for parental relating style, theSPOKES literacy programme revised with more phonics as described abovefor reading, both combined, and a no intervention control group.
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Figure 1. Diagram of HCA study design.
TABLE 2Main measures in the HCA study
Measure
Child
Antisocial behaviour SDQ (P,T); PACS Interview (P); Observation (I)
Attention SDQ (P,T); PACS Interview (P)
Emotional issues SDQ (P,T)
Berkeley Puppet Interview (C)
Social skills SDQ peer, prosocial (P,T)
Attainment BPVS; BAS word reading (I)
WIAT reading comprehension (I)
Attachment MCAST (C)
Parent
Characteristics Occupation; Income; Education; Area (P)
Parenting style Alabama questionnaire (P)
PACS interview (P)
Direct observation (I)
Parent Development Interview (P)
Parental support for reading Reading strategies Interview (P)
Direct Observation of reading (I)
Notes: Informants: P¼ parent; T¼Teacher; C¼Child; I¼ investigator.
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Potential impact of findings
When completed, the findings of the HCA trial will have the potential toinfluence efforts to reduce social inequity. If, for example, improving parentalsupport for reading is indeed the mechanism that leads to better reading, thenit considerably strengthens the case for rolling out programmes to supportspecific parental reading strategies. If, as hypothesized, these work as wellwith disadvantaged families as with others, this will be a major finding,showing that disadvantaged families can benefit from such interventions. Ifchildren with more complex needs respond best to the dual approach of therelationship and reading programme, this would suggest the importance ofidentifying problems early and providing an intensive intervention at thatstage. If there are some subgroups that respond less well, then theinterventions need to be modified, either by increasing the dose or byaltering the content and delivery. The findings from this trial may lead towider dissemination of the two programmes and further trials in the ‘‘realworld’’ to test for cost-effectiveness.
In summary, we have shown that there are both theoretical reasons andpractical evidence to endorse intervening on several child targets throughspecific parenting programmes. The details of how they work needinvestigating, but they herald an exciting new approach for bringing thebest out of children.
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